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. 2014 Jun;11(2):113-9.
doi: 10.3969/j.issn.1671-5411.2014.02.006.

Prognostic value of coronary artery calcium score in patients with stable angina pectoris after percutaneous coronary intervention

Fang-Fang Wang  1 , Jiang-Li Han  1 , Rong He  1 , Xiang-Zhu Zeng  2 , Fu-Chun Zhang  1 , Li-Jun Guo  1 , Wei Gao  1
Affiliations

Prognostic value of coronary artery calcium score in patients with stable angina pectoris after percutaneous coronary intervention

Fang-Fang Wang et al. J Geriatr Cardiol. 2014 Jun.

Abstract

Objectives: To evaluate the prognostic value of the coronary artery calcium (CAC) score in patients with stable angina pectoris (SAP) who underwent percutaneous coronary intervention (PCI).

Methods: A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography (MSCT) were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure balloon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emergency coronary artery bypass grafting. Main adverse cardiac events (MACE) were defined as a combined end point of death, non-fatal myocardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events.

Results: Patients with a CAC score > 300 (n = 145) had significantly higher PCI complexity (13.1% vs. 5.8%, P = 0.017) and rate of procedure-related complications (17.2% vs. 7.4%, P = 0.005) than patients with a CAC score ≤ 300 (n = 189). After a median follow-up of 22.5 months (4-72 months), patients with a CAC score ≤ 300 differ greatly than those patients with CAC score > 300 in cumulative non-events survival rates (88.9 vs. 79.0%, Log rank 4.577, P = 0.032). After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio (HR): 4.3, 95% confidence interval (95% CI): 2.4-8.2, P = 0.038] in patients with a CAC score > 300 compared to patients with a lower CAC score.

Conclusions: The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and procedure-related complications.

Keywords: Angina; Coronary angiography; Heart catheterization; Multi-slice computed tomography; Vascular calcification.

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Figures

Figure 1.
Figure 1.. CAC score is depicted as bars (bar height represents median, error bars represent interquartile range).
(A): The CAC score in DM patients; (B): multi-vessel lesions; (C) complex lesions are significant higher. CAC: coronary artery calcium; DM: diabetes mellitus. T-test was used in two groups and ANOVA was used in three groups.
Figure 2.
Figure 2.. CAC score is depicted as scatter dot plot (median line represent mean, error bars represent range).
CAC were 452.4 and 648.4 with the range 0–2868 and 0–4796 for the patient without and with MACE. CAC: coronary artery calcium; MACE: main adverse cardiac events.
Figure 3.
Figure 3.. Kaplan-Meier survival analysis showed significantly different cumulative event-free survival rates between stable angina pectoris patients with CAC score ≤ 300 and CAC score > 300 (88.9% vs. 79.0%, Log rank: 4.577; P = 0.032).
CAC: coronary artery calcium; PCI: percutaneous coronary intervention.
Figure 4.
Figure 4.. Cox regression analysis showed that adjusted age, gender, family history, history of hypertension, hyperlipidemia, diabetes mellitus and smoking, systolic/diastolic blood pressure, multi-vessel coronary disease, complete revascularization, PCI complexity, and procedure-related complications, the risk of MACE was significantly higher (HR: 4.3, 95% CI: 2.4–8.2; P = 0.038) in patients with a CAC score > 300 compared to patients with a lower CAC score.
CAC: coronary artery calcium; CI: confidence interval; HR: hazard ratio; MACE: main adverse cardiac events; PCI: percutaneous coronary intervention.
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